Mark
I was waiting for a deluge of responses to your mailbase contribution. In some ways I was not surprised at the zero result. Those who firmly believe in what they say whether supported by the majority or not will hopefully continue to stimulate debate and through that debate produce the willingness to consider change and provide a vision for the future. We appear to have lost the fact that despite our personal professional interests we are all part of the one profession and should be able to work together to achieve benefits for all members. Regards, Alan

Alan Crawford
Queensland University of Technology
Brisbane 
Australia 





At 09:04 PM 26/05/2004 +0100, you wrote:
>Alan Borthwick and Olivia Dowd raise a number of important questions
>regarding the relationship between podiatric and orthopaedic surgeons in
>their excellent paper ­ Medical Dominance or Collaborative Partnership?
>Orthopaedic Views on Podiatric Surgery ­ published in the May issue of the
>BJPM. In many ways, the issues highlighted go to the heart of the
>difficulties facing the profession today ­ that of leadership and cohesive
>planning. I would like to explore and expand on the challenging points
>they raise in their summary discussion.
>
>The views collated from orthopaedic surgeons during their study will come
>as no surprise to many within the podiatry community. Podiatrists and
>chiropodists throughout the country have enjoyed close working
>relationships with our colleagues in orthopaedics for many years and with
>the emergence of podiatric surgery a couple of decades ago, we have been
>privy to many considered opinions from the established surgical
>fraternity. Whilst I agree with the authors that some opinions are clouded
>by ignorance, much of what the orthopods have to say has validity. It has
>always struck me as duplicitous that some within our profession view the
>ascendancy of the unregistered sector with disdain and hostility, yet at
>the same time, they regard the position of the British Orthopaedic
>Association as intransigent and protectionist. There is widespread horror
>that a part-time, distance learned ‘chiropodist’ should attain the same
>legal status as a BSc/Diploma graduate through the legislative process of
>the HPC grand-parenting scheme, but at the same time, we seek to impose
>precisely the same set of values to the surgical practice of which the
>Royal College of Surgeons are the established guardians. Is it surprising
>there is such opposition?
>
>One of the principal areas of opposition concerns the use of the
>term ‘consultant’. When you consider the hurdles that have to be overcome
>by medics before they achieve consultant grade, why are we shocked by
>their reticence of accepting podiatrists using the same title after
>undertaking part-time, unregulated training which offers them the same
>platform as themselves? Podiatric surgeons are looking for parity with
>their orthopaedic colleagues, yet they achieve ‘consultant’ grading after
>a fraction of the time in study and training. That cannot be right.
>
>The Chair-elect of the Society of Chiropodists and Podiatrists, Ralph
>Graham, regularly uses the term ‘Consultant Podiatric Surgeon’ on these
>pages. Some years back, Ralph wrote an article describing the
>establishment of podiatric surgery through the Croydon Post-Graduate
>Group, in which he notes they operated at the margins of the law and took
>advantage of the prevailing political climate (apologies Ralph if I use my
>own terminology here - I’m recalling the article from memory- but I think
>the thrust is accurate). The argument was that unless the medical hegemony
>could be circumvented, the aspirations of a few within the profession, to
>further the cause of surgical practice in podiatry along the lines of our
>American colleagues, could not be attained. I think that argument had some
>merit. The medical professions are notorious for their protectionist
>stance ­ a position that has much dubiety. But the argument of introducing
>invasive surgical practice for podiatry, through the backdoor, was also
>dubious. If we seek parity in surgical practice, should we not be prepared
>to undertake the same rigorous training and study as the medics in order
>to compete evenly on the same platform? Perhaps we should have proposed a
>comprehensive grand-parenting scheme to facilitate integration without
>conflict. Dental surgeons who wish to practise oral surgery have to
>undertake FRCS examination and scrutiny and regulation. Should we, in
>podiatry, not be prepared to do the same?
>
>On the whole I agree with many of the comments made by orthopaedic
>surgeons in the Borthwick-Dowd paper. I suspect many of my colleagues in
>the podiatric/chiropodial community feel the same way too. I would go as
>far as to say that the development of this profession has been hindered by
>the actions of a few ambitious individuals, who, in the pursuit of
>personal ambition, have endangered and blighted the career prospects of
>many others by their reckless and selfish actions. In the history of
>British podiatry, it could be said that seldom has much harm been done to
>so many, by so few. The primary reason that many chiropodists and
>podiatrists recognise the comments made by the orthopaedic surgeons is
>that they are the same comments they would apply themselves if they were
>asked. That is highly regrettable.
>
>I would like to open this discussion further.
>
>For the past three years I have tried to engage the podiatric hierarchy in
>discussion about professional development and direction. In many ways I
>have taken advantage of the opportunities afforded by communications via
>the Internet; a medium not enjoyed by our predecessors. I have to confess
>that I have not been entirely successful in that field. The Society has
>resisted all attempts at open dialogue. They have restricted participation
>in their own online forums; refused to contribute in non-affiliated sites
>such as the mailbase and thatfootsite.com. In many ways they have
>simply ‘closed ranks’ and buried their heads to the issues that face us.
>Even in their own forum, many questions from membership go unanswered.
>Yet, time and time again, council members and others in the Society’s
>executive insist they will only answer queries from their own membership
>and refuse dialogue with others on the profession. If the Society had any
>real ambition of attaining the status as the ‘premier podiatry
>organisation’ it must subject itself to close scrutiny by the whole
>profession. Current policy is a farce; it does no-one any favours and is
>doomed to failure. There are however, two prevailing forces in the
>Society, and if we recognise them, it may go someway in explaining the
>presenting hypocritical stance.
>
>The Society is governed predominately by podiatric surgeons and podiatry
>managers. Witness the two established Faculties ­ that of Management and
>Surgery.  They represent around 9% of the total membership, yet their
>influence exceeds the numbers they speak for. Often we are reminded of the
>apathy that reigns supreme in the podiatric community. I suggest that is
>because the vast bulk of membership believes their interests are not being
>well-served; that the Society has become a vehicle for progressing the
>interests of a few at the expense of the many. Where are the proposals for
>progressing the profession?  The Strategic Plan published by the Society
>last December was a disappointment to say the least. Should the Faculty of
>Management not concentrate their minds on producing comprehensive
>proposals for furthering the profession? The only paper on reforming the
>profession has been my own ­ yet I have received no comments from the
>Society’s council on its relevance or validity. Why not? Could it be they
>are against any reform? Could it be the status quo suits them just fine?
>Ralph has made comment about the ‘sleepers’ in the profession. John Mason
>and Bill Liggins (podiatric surgeons not affiliated to the Society) lament
>the apathy of the grass roots ­ only if they mobilise will the profession
>progress. Gentlemen, in all humility, I suggest to you that they will not
>awaken unless you offer them the same terms as you desire yourself.
>General Podiatric Practice is the engine room of this profession. Without
>it you go nowhere. The orthopaedic community will shun you; as will your
>own ­ eventually.
>
>The podiatric community in Britain is crying out for leadership and
>direction. I attended the debate in the Scottish Parliament last month ­ a
>debate that should have been instigated by the Society, not by an angry
>and focussed individual. The podiatry manager in Lothian ­ a colleague
>that I have great respect for ­ lambasted the Society for their
>indifference in matters north of the border. It was a historic occasion ­
>the first time podiatry had been debated in any UK Parliament ­ yet the
>chair, chair-elect and Chief Executive chose to attend a conference in the
>USA instead, leaving representation to a podiatry manager and a policy
>officer (with 2 months experience of the profession). I had to correct
>her; the Society has no real meaning for clinicians’ out-with the M25
>circle; they provide insurance and a monthly circular; that is all. There
>is no vision or leadership. There is no direction. There is no hope. That
>simply must change.
>
>If the Society refuses to reform, should the profession not consider
>forming a new body? One that represents the interests of the many, over
>the ambitions of a few.
>
>Sincerely
>
>Mark Russell
>
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